Intensive Home Hemodialysis: An Eye at the Past Looking for the Hemodialysis of the Future

Multiple observational studies along with a limited number of randomized clinical trials suggest that intensive hemodialysis (IHD) not only improves outcomes for uremic patients undergoing chronic dialysis but does so with a more favorable cost/benefit ratio compared with conventional hemodialysis. As a result of this, there has been a rapid increase in the interest in home hemodialysis (HHD) as HHD represents the easiest means of implementing IHD. While HHD has generated increased interest given its association with better outcomes/reduced hospitalizations, there are very few randomized controlled trials comparing HHD with other hemodialysis methods. Reported HHD‐associated increased survival benefits compared with in‐center hemodialysis are from uncontrolled studies, which raise patient selection bias as underlying the differences found. Thus, while HHD draws increasing attention, studies that pay careful attention to the psychosocial, demographic, and clinical factors associated with patients selected to undergo HHD will be needed to ultimately demonstrate its benefits, clarify the clinical applications, and determine the limits of IHD use in dialysis patients.     

Home dialysis and dialysis treatment modalities in the VA system

A questionnaire was sent to 50 Veterans Administration dialysis centers to inquire about treatment utilization in preparation for a Cooperative Dialysis Study. Thirty-five completed questionnaires in this survey identified a dialysis population of 2,483 patients including 452 contract patients (13.5%). The number of patients treated in-center was 1,101 (48.5%), including 239 on self-care (10.2%), and 930 patients (38.0%) were dialyzed at home. This high utilization rate of home dialysis appears in excess of three times the prevalence of home dialysis experienced overall in non-VA programs. Identification of factors responsible for the present emphasis on home programs in the VA and a corresponding analysis of non-VA programs should provide important information for the planning of future national ESRD policies.     

Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows

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